Stealthy and often deadly, ovarian cancer is the bogey-man of women’s diseases. But modern science is helping women fight back. We talk with expert Ginger Gardner, MD, about how to recognize signs, the latest treatments and finding the right doctor...

With few symptoms to tip off women with the disease, ovarian cancer claims about 14,000 lives a year. Nearly 22,000 new cases will be diagnosed this year in the U.S., according to the American Cancer Society.

Ginger Gardner, MD, a board-certified surgeon and gynecologic oncology expert at Memorial Sloan-Kettering Cancer Center in New York, has made conquering ovarian cancer her life’s mission and has spent more than six years researching and treating this silent killer. She talked with Lifescript about this difficult-to-diagnose cancer:

What do we know about ovarian cancer that we didn’t know five years ago? We used to think that ovarian cancer symptoms were too vague to identify. But recent data shows that it isn’t silent – there are symptoms. We just have to watch out for them.

Women with the disease may experience bloating, abdominal or pelvic pain, difficulty eating and feeling full quickly. You may also notice the need to urinate more urgently or frequently.

Stealthy and often deadly, ovarian cancer is the bogey-man of women’s diseases. But modern science is helping women fight back. We talk with expert Ginger Gardner, MD, about how to recognize signs, the latest treatments and finding the right doctor...

But don’t most women have some bloating a few days a month? And who hasn’t experienced abdominal pain? That’s true, but the key is whether the symptoms are new or happening more frequently.

You’re looking for change. If it’s something you’ve been feeling for 20 years, it’s probably not going to be ovarian cancer. But when one of these symptoms is new, occurs almost daily and lasts longer than 2-3 weeks, you need to see a physician.

You shouldn’t just say, “Oh, I’m getting older” or “It’s just something I ate.”

Will most primary care physicians really consider ovarian cancer when a patient has those symptoms, especially if there’s no family history of cancer? Certainly the symptoms mimic other [problems], but talking about ovarian cancer is the first step.

You should report changes in symptoms to your gynecologist. We have to raise awareness among doctors too.

What should you do if your mom or sister had ovarian cancer?Get a blood test to see if you have the BRCA1 or BRCA2 gene mutation. Women who test positive have a 20%-40% chance of developing ovarian cancer. That’s significantly higher than for women without the gene, who have a 1.5% chance.

Stealthy and often deadly, ovarian cancer is the bogey-man of women’s diseases. But modern science is helping women fight back. We talk with expert Ginger Gardner, MD, about how to recognize signs, the latest treatments and finding the right doctor...

Because breast and ovarian cancer can be linked, women who had breast cancer before age 40 or several family members with either breast or ovarian cancer, should also get tested.

Women of Ashkenazi Jewish descent are at increased risk too and should discuss genetic screening with their physician.

Lastly, if you or a close family member have had uterine or colon cancer before age 50, you should also get genetic testing.

What’s the next step if you test positive for BRCA1 or BRCA2?If you have a BRCA gene mutation, consider getting a CA-125 test and a pelvic ultrasound regularly – every six months. The CA-125 is a blood test for ovarian cancer screening.

It’s not accurate enough for [doctors] to recommend it for all women, but it’s frequently used for those with a genetic predisposition for ovarian cancer.

Should women with the gene mutation have their ovaries removed? Definitely: The CA-125 test and pelvic ultrasound are unreliable. Once childbearing is complete, removing the ovaries and fallopian tubes almost eliminates the odds of getting ovarian cancer. You can reduce your risk for ovarian cancer by up to 95%. The procedure is short and you usually go home the same day.

Stealthy and often deadly, ovarian cancer is the bogey-man of women’s diseases. But modern science is helping women fight back. We talk with expert Ginger Gardner, MD, about how to recognize signs, the latest treatments and finding the right doctor...

Why the remaining 5% risk?Women who remove their ovaries won’t get ovarian cancer, but there’s still a slim chance they’ll get a cancer of the fallopian tube or peritoneum, the lining of the abdomen.

That’s because those ovarian cancer cells develop from the same type of cell that lines the ovaries’ surface. But generally, those cancers are rare.

Other than genetics, what raises your ovarian cancer risk? Women who have more menstrual cycles – those who get their periods at a young age or don’t go into menopause until much later – are at greater risk. So are women who never have children.

The theory is that every time a woman ovulates, an egg is released from the ovary's surface, which then has to repair itself. The more times that has to happen, the [more likely] the repairing process can get impaired and a problem can develop on the surface of the ovary.

Is that why the birth control pill is thought to prevent ovarian cancer? Yes, taking the pill can reduce your risk by as much as 50%. That’s a big benefit. The pill stops ovulation, so you’re not releasing eggs and the ovary doesn’t have to repair itself.

Stealthy and often deadly, ovarian cancer is the bogey-man of women’s diseases. But modern science is helping women fight back. We talk with expert Ginger Gardner, MD, about how to recognize signs, the latest treatments and finding the right doctor...

The longer you’re on the pill, the more benefit. The good news is, even if you took the pill in your 20s or 30s, that protective benefit will continue for many years. When you’re deciding on birth control options, this is an important health benefit to consider.

But is the pill safe after age 35? Yes, you would need to discuss this with your health-care provider, but many women can take the birth control pill after age 35 as long as they don’t smoke and have no history of blood clots.

When is the best time for ovarian cancer treatment? There are four stages of ovarian cancer. In general, [women with] cancer caught in the earlier stages have a better survival rate.

We continue to work to improve outcomes as new approaches and treatments are developed.

How has ovarian cancer treatment changed? There are continual advances being made – both in surgery and the drugs we use to treat this disease. Specifically, we’ve gotten much better at debulking surgery.

Surgery to remove ovarian cancer from the upper abdomen and the diaphragm is now being done on a regular basis.

Stealthy and often deadly, ovarian cancer is the bogey-man of women’s diseases. But modern science is helping women fight back. We talk with expert Ginger Gardner, MD, about how to recognize signs, the latest treatments and finding the right doctor...

In some cases, we use a special procedure known as a thorascopy to make sure the chest is clear of disease as well.

Cancer cells from the ovarian surface can float freely to the upper abdomen, where they can attach and grow. When ovarian cancer is in the chest, which is rare, it means it has spread and is in the most advanced stage.

If the large, bulky disease is removed, then the second part of treatment, chemotherapy, is much more effective because it has to go after fewer cells.

Several years ago, a study came out about IP chemo. What is that? Intraperitoneal (or IP) chemotherapy is when a small temporary tube is placed into the peritoneal cavity during [debulking] surgery, so we can give chemotherapy directly into the abdomen where the cancer cells grow.

It makes chemo even more effective, allowing the drug to be concentrated where you need it most.

A study in The New England Journal of Medicine found that, on average, women treated with IP chemo lived an additional 16 months beyond those who didn’t get the treatment.

Stealthy and often deadly, ovarian cancer is the bogey-man of women’s diseases. But modern science is helping women fight back. We talk with expert Ginger Gardner, MD, about how to recognize signs, the latest treatments and finding the right doctor...

So while IP chemo has more side effects than traditional chemo, women who have it live longer.

In women with a successful debulking surgery followed by IP chemo, we are seeing tremendous improvements in survival.

Some cancers are now being treated with drugs that choke off the tumor’s blood supply. Does that work for ovarian cancer treatment? That’s another exciting area of research: the use of biologics or targeted therapeutics.

This treatment blocks a specific way in which tumor cells grow. When a tumor is growing, it needs a steady supply of blood.

We now have drugs that choke off the tumor’s ability to recruit more blood vessels to support its growth. These are known as VEGF (vascular endothelial growth factor inhibitors) and they’re being used more frequently to treat ovarian cancer.

What’s good about these drugs is that they have fewer of chemotherapy’s traditional side effects and they provide yet another avenue to get rid of ovarian cancer cells.

Many other targeted therapeutics are in development and clinical trials as well.

Stealthy and often deadly, ovarian cancer is the bogey-man of women’s diseases. But modern science is helping women fight back. We talk with expert Ginger Gardner, MD, about how to recognize signs, the latest treatments and finding the right doctor...

Even so, ovarian cancer is still very deadly, right? Yes, ovarian cancer is a challenging disease.

For many years, we thought it produced no symptoms. But we now know that many women with ovarian cancer do have symptoms. The fact the symptoms may be vague or mimic other problems, however, often delays diagnosis and makes it difficult to detect ovarian cancer.

What kind of doctor do you go to for ovarian cancer treatment?
Women diagnosed with ovarian cancer need a gynecologic oncologist. We specialize in gynecologic cancers of the female reproductive tract, including the uterus, ovary, cervix, vagina and vulva.

To find a specialist in your area or to learn more about these cancers, I recommend the Women’s Cancer Network.

Stealthy and often deadly, ovarian cancer is the bogey-man of women’s diseases. But modern science is helping women fight back. We talk with expert Ginger Gardner, MD, about how to recognize signs, the latest treatments and finding the right doctor...

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